Between 1892 and 1954, Ellis Island served as the only entry point into the United States for more than twelve million immigrants. A small island inside New York Harbor located just off the New Jersey coast and the nearby Statute of Liberty, Ellis Island grew over the years from its original 3.3 acres to 27.5 acres in size.
Before 1890, individual states regulated immigration. When the Federal government assumed this responsibility, it constructed and operated a new facility on Ellis Island, opening its doors on January 1, 1892.
For the most part, class and status dictated whether an immigrant was sent to Ellis Island. Travelling across the Atlantic Ocean (the only real viable option at the time), first and second-class passengers were only sent to Ellis Island if they were sick (or had legal issues). Third class passengers, also known as “steerage”, would almost always be sent to Ellis Island by ferry or barge for a medical examination.
If one’s legal documents were in order and he or she appeared to be in good health, the time spent on Ellis Island would be brief. Doctors conducted medical examinations by quickly scan all newcomers for obvious physical ailments (sometimes referred to as the “six second physical”).
Fearing danger to the public health, immigrants with contagious diseases were excluded from entry into the United States. As a result, a hospital was needed on Ellis Island to treat the immigrants and protect the public health, and it opened in 1902. The contagious disease hospital was built with 18 wards for specific diseases, and it also included a psychiatric hospital. Eventually the hospital would grow to include 22 buildings on Ellis Island.
A report by Assistant Surgeon General H.D. Geddings in 1906 stated: “The hospital building is of modern construction, on the block plan, of brick and stone construction, architecturally very handsome, and three stories and an attic in height, with a basement. The general plan of the building is a central portion for executive and administrative purposes, with wings containing large and small wards.”
The Ellis Island Hospital received heat, light and power from a plant on Ellis Island. The hospital’s kitchen prepared 2,000 meals each day for the immigrants and 300 employees. According to the Commissioner of Immigration, Federic C. Howe, in 1916 Ellis Island would accommodate “as many as 10,000 people temporarily or permanently.”
The Ellis Island Hospital handled all diseases, including measles, mumps, diphtheria, and whooping cough. The hospital also had its own state-of-the-art laboratory, critical at the time to identify cases such as pulmonary tuberculosis. Indeed, the hospital reported only one employee death due to infection with contagious disease (tuberculosis) while working with the immigrants.
According to Dr. Milton Foster in 1915, “The medical inspection of arriving immigrants is made chiefly for two purposes; first, to see that they are strong, well, and bright enough to be able to earn a living and get along in this country; and second, to ascertain that they do not have certain diseases which they might transmit to their new neighbors in America.” While it treated disease and the passing of 3,500 patients, Ellis Island Hospital also delivered 350 babies (receiving immediate citizenship at birth).
The hospital screened immigrants for mental illness as well, usually a process initiated with an “X” chalk marked on the jacket or dress of the immigrant. According to Dr. Thomas Salmon in 1905: “Justice to the immigrant requires a carefully considered diagnosis; while on the other hand, the interests of this country demand an unremitting search for the insane persons among the hundreds of thousands of immigrants who present themselves annually at our ports of entry.”
Physicians from the U.S. Public Health Services were required to rotate through the hospital. The patient load on Ellis Island was challenging. According to Dr. Foster, the volume compared to that of the hospitals in both Boston and Washington, D.C.:
“Take any week in the year and imagine that, during this week, all the people who were sick and needed treatment in [Boston and Washington, D.C.] were to be sent to one hospital. Assume, also, that this hospital was a real general hospital, in the fullest sense of the word, and that it accepted not only ordinary patients but also the insane and those suffering from contagious diseases. Let us also further suppose that all . . . were inspected and that all those who were suspected of having latent disorders, like tuberculosis or syphilis, were also sent to this hospital for examination and treatment. Grant all of these conditions and you will have a pretty fair idea of the total amount of work performed by the hospital at Ellis Island last year.”
Restrictions on immigration ultimately proved to be the end of Ellis Island Hospital. Additionally, physical screenings were conducted overseas before transatlantic voyage was permitted.
As the number of patients began to decrease, Ellis Island was used by other government agencies such as the FBI (using the island to deport possible foreign spies), the U.S. Army (during World War II for its disabled servicemen as well as German and Italian prisoners of war), and finally the U.S. Coast Guard. In fact, it was the U.S. Coast Guard that ultimately closed the facility in 1954.
Photographs from EllisIsland.org, NewYorkTimes.com, and U.S. DHHS.
The Centers for Medicare and Medicaid Services (CMS) will start paying hospitals bonuses based upon performance, an adherence to quality measures, and on patient satisfaction. These final Medicare rules were published last week. This Hospital Value-Based Purchasing Program is another step toward shifting the reimbursement infrastructure from the cost of services during a hospital stay to improvements in patient health and performance during a hospital stay.
